Unlike the milk of many other mammals, human milk contains a high amount of diverse complex sugars called human milk oligosaccharides (HMOs). The composition varies between women and, to a certain extent, changes over the course of lactation. Current research focuses on the maternal factors that drive HMO variation and aims to understand how HMO composition impacts immediate and long-term infant health and development.

A real world study with an infant formula enriched with two HMO was done in Spain in 2018. The paper was presented at the last ESPGHAN meeting in June by Dr. Enriqueta Román Riechmann, who was the main researcher of the study. Here there are some of the
results of that NEHMO study.

The early-life gut microbiota establishes and matures sequentially during infancy and early childhood. An age-appropriate microbiota maturation is important for normal digestive, immune competence and metabolic development.

Vitamin D is a key component for the growth and development of children and adolescents, influencing a multitude of functions. In Germany as well as in many other countries worldwide it has been recognized that there is a need for a higher vitamin D intake in all age groups, from infancy to older ages (Cashman et al. 2016, Kunz et al. 2018, Zittermann 2018).

The idea that nutrition in early life may influence, or programme, later health first emerged in the 1960‘s with the work of McCance (Singhal A, Lucas A., Lancet 2004).
He showed that rats raised in small litters, and therefore overfed post-natally, were larger in adulthood.

The ability of human to perform complex mental activities including thinking, reasoning, remembering, problem solving, decision making, and learning new information are possible thanks to the ability of the brain to alter its functional and structural organization as a result of experience which is referred to brain plasticity. Moreover, development and full maturation of such a formidable organ is thought to take more than 3 decades.

The fetus receives high amounts of amino acids and some carbohydrates, whereas the term newborn infant gets a low protein diet, lots of carbohydrates and, lots of fat. In preterm infants this transition from fetal nutrition to term newborn nutrition happens in the neonatal ICU and actually, we do not know the best nutrition for the preterm infant.

Feeding tolerance in preterm babies < 32 weeks is getting more and more a topic because the survival rates are getting better. However, many of these babies have growth failure
and end up being too small to be 36 weeks old, the time they are usually discharged.

The role of the nutritional environment throughout early development in modulating later health outcomes is in the spotlight. As the evidence base guides both public policy development and clinical practice gui- dance, it is timely to consider the current state of the art on vitamin D requirements in infancy and in particular, in preterm infants.